改良椎间孔镜技术治疗腰椎间盘突出症的疗效分析*

Treatment of lumbar disc herniation with modified transforaminal endoscopic surgical system*

摘要:

探讨改良椎间孔镜技术治疗腰椎间盘突出症（LDH）的疗效及影响因素。方法 回顾性分析2013年11月-2016年5月该院行改良腰椎间孔镜技术治疗LDH并获得完全随访的患者178例。比较术前及随访时视觉模拟评分（VAS）及日本骨科协会评分（JOA）。用改良MacNab标准进行疗效评价，观察其疗效并对可能影响疗效的因素进行分析。结果 ①腰痛VAS评分、腿痛VAS评分及腰椎功能JOA评分3个指标均明显改善（P <0.01）；改良MacNab标准评定：优57例、良85例、可20例、差16例，优良率79.8%，有效率91.0%；②单因素分析结果显示：年龄、病程、同节段手术史、症状和突出物钙化等5项因素疗效存在相关性（P <0.05）。多因素分析结果显示：年龄≥45岁、有同节段手术史、麻木症状是影响疗效的独立危险因素（OR值分别为5.04、3.03、5.55）。结论 ①改良椎间孔镜技术治疗LDH疗效确切，可显著改善患者症状；②年龄、病程、同节段手术史、症状和突出物钙化等因素可影响患者疗效，且年龄≥45岁、有同节段手术史、麻木症状为改良椎间孔镜技术治疗LDH的独立危险因素。

Abstract:

To explore the clinical effects and influence factors in the treatment of lumbar disc herniation (LDH) by the application of modified transforaminal endoscopic surgical system. Methods Clinical data of 178 cases with LDH  from November 2013 to May 2016 was retrospectively analyzed and totally followed-up after surgery. Compare the scores of VAS and JOA preoperative and in the follow-up, the efficacy evaluation was performed using modified MacNab system, the effectiveness was observed and the factors that might affect the efficacy were analyzed. Results The VAS score in the back pain, leg pain and JOA of lumbar vertebral function, those three indexes were significantly improved (P < 0.01). Modified MacNab system: 57 cases in excellent, 85 cases in good, 20 cases in fair and 16 cases in poor, with an excellent and good rate of 79.8% and 91.0% efficiency; The results of single factor analysis showed that there was a correlation between age, course of disease, history of surgery in the same segment, symptoms and calcification of prolapse objects (P < 0.05). The results of multi-factor analysis showed that age above 45 years old, history of surgery in the same segment and numbness were the independent risk factors (OR values are 5.04, 3.03 and 5.55) that affect the curative effect. Conclusions The treatment of LDH by modified transforaminal endoscopic surgical system is effectiveness and can significantly improve the symptoms of patients; Age, course of the disease, surgery history with the same segment, symptoms, calcification of prolapsed objects can affect curative effect, and the age above 45 years old, surgery history with the same segment, numbness symptoms were the independent risk factors for the treatment of LDH with modified transforaminal endoscopic surgical system.